Articles: low-back-pain.
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J Manipulative Physiol Ther · Nov 1994
Case ReportsManipulation under anesthesia combined with epidural steroid injection.
To demonstrate the benefit of cooperation between medical and chiropractic specialists and the usefulness of combining chiropractic and epidural injection in particular cases of back pain. ⋯ Cooperation between medical and chiropractic specialists is to be encouraged. These cases demonstrate cooperation between an anesthesiologist and a chiropractor. By using a single treatment of manipulation under epidural anesthesia/epidural steroid followed by continued chiropractic, we were able to lead our patients out of therapeutic dead ends and deal with the dilemma of a patient in too much pain to tolerate an initial chiropractic treatment.
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Seventeen drawings of localised low-back pain were analysed by two assessors using 4 systems. Three were grid-based systems and one was by computer. The mean area or 'extent' was calculated to be 7.7%, 4.7%, 3.6% and 2.3% of the body outline using 45, 200, 560 and 61,102 section analyses, respectively. ⋯ Correlation coefficients of extent between the systems varied from 0.46 to 0.94. Correlation was highest between systems of adjacent magnitude of sections. It is concluded that grid-based assessment of small areas overestimates the actual area of pain and this may account for the lack of sensitivity to change in clinical status.
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Lumbar facet joint syndrome is a common condition, involving about 79% of patients suffering from low back pain. Denervation by scalpel or electrofrequency is a well-known method of treating it. An alternative method for longer lasting pain relief is CT-guided intraarticular infiltration of facet joints with local anaesthetics and cortisone. ⋯ CT-guided facet joint infiltration is a good method for treatment and diagnosis of lumbar facet joint syndrome. It can be repeated and has no severe side effects. The best results were seen in patients with spondylarthrosis of the facet joints. After lumbar disc surgery the pain relief was shorter, though it also yielded good results. For patients with unspecific low back pain, facet joint injections are a very good diagnostic method, allowing definite exclusion of lumbar facet syndrome.
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Comparative Study
The use of the percentage change in Oswestry Disability Index score as an outcome measure in lumbar spinal surgery.
A retrospective analysis of the change in the Oswestry Low Back Pain Disability Questionnaire in a heterogeneous group of 144 operatively managed patients was undertaken to examine the change in disability index as an outcome measure. ⋯ The findings indicate that the absolute value and change in these scores after surgery vary from patient to patient, but that their percentage change is likely to be the best marker of outcome when such subjective scoring systems are used.